Open Fx

Question 1

Which of the following statements is FALSE regarding the Gustilo-anderson open fracture classification scheme?
• There are 4 categories, with type III having subcategories A-C
• Type II is considered an open fracture with a wound > 1 cm without extensive soft tissue damage, flaps or avulsions
• Scheme is designed to correlate with treatment guidelines and prognosis
• This scheme results in only moderate (60%) interobserver agreement

Answer 1

A false (only 3)

Question 2

What do these initials stand for in the proposed orthopedic trauma association  classification scheme (w/ mild, moderate, severe subgroups)
•	S =
•	M = 
•	A = 
•	B = 
•	C =

Answer 2

S = skin
M = muscle
A = arterial
B = bone loss
C = contamination

Question 3

Which of the following is FALSE regarding wound treatment and antibiotic therapy?
• The desired pressure to lavage a wound is 7 to 8 psi and can be accomplished with a 1L fluid bag and the pressure raised to 300 mmHg
• A human study shows that in regards to the timing of antibiotics there was no difference in infection rate once a patient is 2 hours after injury.
• Successful treatment depends on prompt and aggressive debridement of contaminated tissues, administration of abx, and restoration of soft tissue coverage to healing bone, tendons, ligaments, neurovascular structrues
• Isotonic fluids or a solution of 0.05% chloxidine solution can be an effective lavage

Answer 3

B FALSE- within 3 hrs 4.7% and >4 hrs 7.4%)

Question 4

Which of the following is FALSE regarding open fracture infections?
A. The infecting organisms tends to be nosocomial, rather than one of the initial contaminants at the time of injury
B. Surgical approach away from the open wound should be performed.
C. Fracture fixation with external fixators has demonstrated lower infection rates compared to internal plate fixation.
D. Infection rates increase from Type I to Type III open fractures

Answer 4

C

Question 5

Which of the following is true regarding negative pressure wound therapy.
A. It is applied 120mmHg intermittently or continuously to the wound bed.
B. Increased interstitial edema
C. Delays wound contraction
D. Accelerates granulation tissue formation

Answer 5

D is true

A. 125 mmHg
B. decreased interstitial edema
C. promotes wound contraction
ALSO increase tissue blood flow, increases bacT clearance

Question 6

What are the infection rate for Types I, II and III open wounds?

Answer 6

I 0-2%
II 2-10%
III 10-50%